RE:view, volume 37, Number 3, pages 109-116, Fall 2005.
Reprinted with permission of the Helen Dwight Reid Educational Foundation.
Published by Heldref Publications, 1319 Eighteenth St., NW, Washington, DC 20036-1802.
Copyright © 2006.
RE:view - Fall 2005
Teaching Deaf-Blind People
to Communicate and
Interact With the Public
Critical Issues for Travelers Who Are Deaf-Blind
Eugene Bourquin and Dona Sauerburger
Travelers with dual sensory losses present the rehabilitation professional with additional
tasks and responsibilities that expand the instructional curriculum. Effective
instruction in rehabilitation and orientation and mobility includes teaching strategies
and tools for dealing with unfamiliar people through communication (conveying information)
and interaction (knowing when and how to use specific communication techniques).
Incorporated in those two skills are acknowledging the public’s typical lack of
awareness of the nature of deaf-blindness, understanding that the traveler knows his or
her own needs better than others do, and being able to assert one’s needs effectively.
Teaching effective techniques for communication and interaction, skills that are critical
elements for the quality of everyday life, is a necessary component of comprehensive
rehabilitation. Unless instructors address these additional needs of students who
are deaf-blind (see note), comprehensive rehabilitation is not possible.
Although travelers who are deaf-blind present challenges because dual sensory loss
may affect many interpersonal transactions, professionals can and should design
instruction that addresses real-world circumstances and assist travelers in overcoming
barriers found in everyday activities. The past several decades have seen the development
of various approaches to addressing many of these challenges (DeFiore & Silver,
1988; Florence & LaGrow, 1989; Franklin & Bourquin, 2000; Gervasoni, 1996; Lolli
& Sauerburger, 1997; Sauerburger, 1993; Sauerburger & Jones, 1997). In this article,
we assume knowledge of these strategies and methods and will not present a detailed
review of those approaches. Rather, we consider the communication and interaction of
people who are deaf-blind with the public and the teaching techniques that we have
found effective. The techniques we present are the results of our collective experiences
with people who are deaf-blind, including several decades of instructing these travelers
in community-based and residential settings.
Effective Communication Strategies
Choosing which communication strategy to use depends on the person’s hearing,
vision, and language skills; cognitive abilities; comfort; and assessment of the risk. The
more methods that the person can use skillfully, the easier communication with the public
will be. People who are deaf-blind can communicate with the public through gestures,
in writing (prepared or ad hoc), orally (spoken or prerecorded), or by presenting symbols
and pictures. The public can respond to the person who is deaf-blind by tapping the person
on the arm or shoulder, some form of written messages (e.g., printing on the palm of
the hand, using devices such as an alphabet card, writing on paper), speaking, presenting
yes or no signals, and exhibiting actions or behaviors.
Generic cards and tools are not always effective. The design of the communication
should match the physical and cognitive needs and skills of the person who is deaf-blind
and provide the public with quick and easy ways to respond. For example, cards may be
made that assist a person who is deaf-blind to arrive at certain destinations; that guide him
or her to the counter at a store or business, to a certain bus, across a street; or that provide
certain assistance on a train or airplane. The variety of cards and messages that can be
created is as endless as the list of specific needs of these travelers. Some situations require
a communication tool that provides the public with a limited choice of responses: for the
person who is deaf-blind and has limited understanding of English or to communicate
with people who have limited time, such as bus drivers or salespeople.
Communication cards can be developed for multiple purposes. A card may have a
variety of labels that can be attached with Velcro to complete a sentence, such as
“Please guide me to the (insert the name of a store or business)” or “I would like to
order (insert a food item).” In Seattle, people who are visually impaired can flag buses
by using tools in which the number of the bus is inserted into a clear plastic sleeve.
Examples of Tools Created for Specific Purposes
Scenario A. A man needs to ask a busy station clerk from which train platform his
daily commuter train departs. A communication card is designed that he could pass
through the glass partition to the clerk. The card has a series of track numbers along
the top in both print and Braille and a paper clip attached to the card at a default section
labeled “NO TRACK YET,” to indicate that the clerk does not yet know from which
track the train will depart. A message on the card requests the clerk to move a paper
clip to the correct track number and return the card to the traveler. See Figure 1.
FIGURE 2. Example of a fill-in-the-blanks card.
Scenario B. A woman who is hard of hearing and visually impaired wants to ask a
bus driver to let her off at the bus stop nearest to her destination but needs to find out
where that stop is. She makes a map of the appropriate area and writes a note asking
the driver to point to the bus stop nearest to her destination.
Scenario C. A young man who is deaf and visually impaired and has limited English
skills presents a salesperson with a note asking for a certain item. He is unable to understand
the salesperson’s lengthy written response, which explains that the item is out of
stock and will be available when the truck arrives the following week. By creating a
fill-in-the-blank note (see Figure 2), he can indicate what he wishes to purchase and the
salesperson can let him know whether the store carries the item and if it is in stock or
when it will be in stock.
I would like to purchase a _____________. Please check the following:
____ We have the item and I will bring it to you.
____ We do not carry that item.
____ We carry that item but it is out of stock; we should have it by ________.
Keep the Communication Simple and Focused
Effective Strategies for Interaction With the Public
- Group related communication tasks and tools together. Travelers using public transportation,
for example, can use a plastic document holder or pencil case to store cards
or equipment to communicate with the bus driver, a fare card or change to pay for the
fare, identification and reduced fare cards, and other necessities such as emergency
information. A notebook, small photograph album, or a ring can hold separate sets of
communication cards developed for specific travel needs: one set for grocery shopping,
another for requesting items in a restaurant, and a third for traveling a route on foot.
- Cards should be easy to identify. Tactile indicators, such as corners that are cut or
bent or a Braille label, or visual indicators, such as color-coding the cards or having
pictures or symbols on the cards, such as a picture of a telephone, can help the person
who is deaf-blind quickly find the appropriate card. Each tool should be easy to use,
sequenced in priority or in the order in which it is to be used, and easily accessible physically.
Tools should also be comfortable to handle and store.
- The message should be short and concise. A message that presents a vague request
or an open-ended question may produce a lengthy and confusing response. For example,
text such as “I am lost. Can you help me? I am deaf and blind. Thank you” invites
a variety of responses. A narrow and pointed message such as the following will elicit
either a positive response or no response: “I am lost. Please call (name and phone number)
and tell them my current location. Tap my arm twice if you can help. I am deaf
and blind. Thank you.”
The inability of the uninitiated public to identify quickly and easily the specific
assistance being requested can be a major impediment to effective communication
(Sauerburger & Jones, 1997). Many pedestrians and retail employees do not have the
time or impetus to comprehend a wordy request. Conveying messages or requests to
the public in simplified language typically provides the best results.
In addition to knowing how to communicate with the uninitiated public, people
who are deaf-blind need to know how to interact with them: how to get someone’s
attention; how to assert their needs. Probably the most common problem that occurs
when interacting with the public is for the person who is deaf-blind to assume that the
other person knows they are deaf-blind and knows how to help and communicate with
them. When other people do not act as expected, the person who is deaf-blind often
assumes it is because those people are rude or do not like people who are deaf-blind.
They do not realize that the people have no ability to interpret this typical situation
properly. People who are deaf-blind sometimes begin to mistrust the public and avoid
traveling when and where they must interact with other people. Understanding the
following principles for successful interaction can help people who are deaf-blind
1. The deaf-blind traveler should be aware that others do not understand the situation
and do not know what to do. Even when given an explanation, many people will
not understand because they are dumbfounded, are not paying attention, or are incredulous
that a person who is deaf-blind can travel independently. Therefore, the deaf-
blind person will need to explain, often more than once.
Getting the Public’s Attention
2. When asking for assistance, whether with a written or spoken message, it is best
to give the following information in this specific order: (a) the help needed (e.g., crossing
the street, finding the correct bus, getting information), (b) exactly what the person
who is deaf-blind wants the other person to do, (c) an explanation that the person is
deaf and blind or visually impaired and hard of hearing, and (optional) how to communicate
(Sauerburger & Jones, 1997). See Figure 3.
To communicate effectively with the public, people who are deaf-blind need to get
people’s attention and convey that they want to communicate or receive assistance. To
do this, it is best for them to stand where they are most visible and where others are
likely to be, at locations such as a bus stop or store entrance. More people are likely to
be at street corners than at midblock. People who are deaf-blind should make certain
not to stand behind a bush or pole where they cannot be seen. They can use an electronic
travel aid to recognize when people are passing, go into stores or businesses to
find people to help, or perhaps even approach people’s homes, if they are not concerned
about the safety of doing this.
Having gotten people’s attention, travelers who are deaf-blind must make it clear
that they want assistance, or the public will simply pass by (Sauerburger & Jones,
1997). The following strategies may be effective for this purpose:
Building Backup and Fail-Safe Tools
- Use body language. Effect a puzzled look; shift the body as if uncertain or looking
for help. Do not stand confidently and smile.
- Hold up a card or speak or use a tape-recorded message that asks for specific help.
Large, brightly colored cards with big, bold print attract more attention. Recorded messages
must be clear and sufficiently loud to be understandable. In many environments,
it is impossible to hear recorded messages.
A fail-safe strategy is one that reliably informs the user when techniques are not
working; a backup plan handles situations when the original strategy does not work or
unpredictable situations occur. Developing several ways to communicate and interact
increases the probability of a successful interaction.
A fail-safe strategy and backup for a commonly occurring problem. Travelers who are
deaf-blind use communication cards to inform bus drivers where they want to get off the
bus. Frequently, drivers misunderstand and assume that the communication card is something
else, such as a bus pass, or they simply refuse to read the card (Cioffi, 1996).
Devising backup procedures for the various situations that may arise puts decision
making into the hands of the individual who is deaf-blind. Incorporating them into travel
plans may circumvent frustrating and unsuccessful experiences and give the traveler confidence
One successful strategy is to have a card that requests the bus driver to keep the card
until the bus arrives at the desired location and then return it as a signal that it is time
for the traveler who is deaf-blind to get off. The traveler presents the driver with the
front of a communication card on the bottom of which are the words “PLEASE KEEP
THIS CARD UNTIL WE REACH MAIN STREET AND FIRST AVENUE.” The bus
driver glances at the card without reading it and signals the rider to proceed into the
bus. The traveler again presents the card for the driver to read and keep. The driver,
still not reading or understanding the card, does not take it. This card is a fail-safe
strategy because the traveler automatically knows it is failing and can implement the
The traveler then turns over the card, where a message in large print reads “PLEASE
READ THE OTHER SIDE OF THIS CARD. I AM DEAF AND BLIND. THANK
YOU.” When presented with this message, the driver reads the message on the front
and keeps the card. If the driver does not, the traveler leaves the bus.
For longer trips on public transportation on which the person who is deaf-blind is
relying on the driver or conductor to inform her when to get off, the traveler may be
forgotten and miss her or his stop because public transportation employees attend to
many tasks and deal with many customers. Therefore, devising a way to reconnect
with the employees and remind them of the traveler’s destination is often wise. The
person who is deaf-blind can set a timer at the beginning of the trip to alert him or her
when it is time to remind the employee that the destination stop or station is coming
up soon. (Vibrating kitchen timers are readily available in many catalogs of independent
We believe that this area of inquiry is rich with potential and mostly unexplored.
Insufficient published research exists concerning the many communication and interaction
possibilities for travelers who are deaf-blind. Many of those individuals navigate
simple and complex communication situations daily, and probably many of their strategies
and successes are as yet undocumented.
We have found that the following procedure has proven highly effective for communicating
and interacting with the public.
Preparing for Experiences With the Public
Before Going out on Each Session
- The instructor and traveler consider possible communication techniques and
choose as many as are appropriate and feasible.
- The traveler practices the techniques and becomes skillful with them. The instructor
reviews with the traveler the two principles for successful interaction listed on page 113.
Trying the Communication Techniques With the Public
- The traveler prepares all necessary notes, cards, or equipment.
- The traveler prepares backup plans or fail-safe procedures.
- The instructor and traveler brainstorm ways that the traveler can get people’s
attention and assistance in each expected situation.
It is best if the traveler first practices simple situations that eventually become more
unstructured. An example of the hierarchical order to follow for lessons starts with
getting help to cross streets (very structured communication). The next steps are shopping
in small stores, shopping in large department stores, riding a bus, and, finally,
soliciting aid to reach an unfamiliar destination or when lost.
The instructor does not prepare the public for the interaction ahead of time. During
the interaction, the instructor observes unobtrusively and does not intervene. Thus, the
person who is deaf-blind can experience actual interaction and learn the effectiveness
of her or his communication skills. After the experience, the instructor provides objective
feedback about what he or she observed, brainstorms with the student about why
the interaction did or did not work, and suggests new ideas to improve the interaction.
Instructors should be aware that the level of acceptable risk and benefits of communication
and interaction with the public must be decided only by the person who is
deaf-blind. Although the instructor can teach strategies and explain possible consequences,
individuals who are deaf-blind must judge each situation for themselves and
make the final determination of whether to incorporate or reject techniques. What
might be a simple task for one individual may be untenable for another person. As part
of instruction, rehabilitation professionals should include self-assertiveness and self-
advocacy as a primary component to the greatest degree possible.
We have chosen to use the term deaf-blind. This is the nomenclature of the major consumer
organization in the United States, American Association of the Deaf-Blind (AADB), and the
largest rehabilitation agency, the Helen Keller National Center for Deaf-Blind Youths and Adults.
It was also the preference of individuals who are deaf-blind in a survey conducted by AADB.
Cioffi, J. (1996). Orientation and mobility and the usher syndrome client. Journal of Vocational
Rehabilitation, 6, 175–183.
DeFiore, E. N., & Silver, R. (1988). A redesigned assistance card for the deaf-blind traveler.
Journal of Visual Impairment & Blindness, 82, 175–177.
Florence, I. J., & LaGrow, S. J. (1989). The use of a recorded message for gaining assistance with
street crossings for deaf-blind travelers. Journal of Visual Impairment & Blindness, 83,
Franklin, P., & Bourquin, E. (2000). Picture this: A pilot study for improving street crossings for
deaf-blind travelers. RE:view, 31, 173–179.
Gervasoni, E. (1996). Strategies and techniques used by a person who is totally deaf and blind
to obtain assistance in crossing streets. RE:view, 28, 53–58.
Lolli, D., & Sauerburger, D. (1997). Learners with visual and hearing impairments. In B. B.
Blasch, W. R. Wiener, & R. L. Welsh (Eds.), Foundations of orientation and mobility (2nd ed.,
pp. 513–529). New York: AFB Press.
Sauerburger, D. (1993). Independence without sight or sound: Suggestions for the practitioner
working with deaf-blind adults. New York: AFB Press.
Sauerburger, D., & Jones, S. (1997). Corner to corner: How can deaf-blind people solicit aid
effectively? RE:view, 29, 34–44.
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